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Advanced Med Surge > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

How is fluid volume managed for the patient with chronic kidney disease?

A

Strict I’s and O’s
Daily weight (1 kg = 1 L of fluid)
ESA’s
Diuretics

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2
Q 
Burning and gnawling pain in upper abdomen
Nausea and vomiting
Unexplained weightloss
Signs of diabetes mellitus
Fatigue
Steatorrhea stools

These are manifestations of?

A

Chronic pancreatitis

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3
Q

Renal artery stenosis
Heart attack
Heart failure
Infection (sepsis)

Prerenal/Intrarenal/Postrenal?

A

Prerenal

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4
Q

True/False: A consent is needed for a patient that requires hemodynamic monitoring.

A

True

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5
Q

Normal Hct level? (inlude male to female)

A

37-52 %

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6
Q

What are the late signs and symptoms of Hepatic Encephalopathy?

A

Altered level of consciousness
Impaired thinking processes
Neuromuscular problems

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7
Q

Normal Calcium level?

A

8.5-10

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8
Q

Normal Potassium level?

A

3.5-5

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9
Q

Nursing interventions for Stage 5 Chronic Kidney Disease?

A

Implement renal replacement therapy or kidney transplantation.

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10
Q

Normal BUN level? (include male to female)

A

10-20

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11
Q

How does the nurse manage TTP?

A

Remove the plasma and give fresh frozen plasma. Aslo give ASA an alprostadil.

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12
Q 
Tachycardic
Hypotensive
Systolic BP less than 90 or less or 30 less than the patients normal
Urine output - 0.5-1 mL/kg/hr
Cold/ clammy skin with poor peripheral pulses
Agitation
Confusion
Restlessness
Pulmonary congestion
Tachypnea
Continuing chest discomfort

Are all signs of what?

A

Cardiogenic shock

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13
Q

When is a splenectomy necessary for a patient with ITP?

A

When it is the cause… however it puts the patient at risk for infection.

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14
Q

Normal Magnesium level? (from book)

A

1.3-2.1

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15
Q

What happens in HIT?

A

Antibodies activate platelets in the presence of heparin which can cause a thrombus.

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16
Q

What are the early manifestations of cirrhosis?

A 
Fatigue
Weight loss
Anorexia
Nausea and vomiting
Abdominal pain
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17
Q

How many times a week will a patient have to go to hemodialysis?

A

3-4 times a week

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18
Q

What drugs should patients with cirrhosis avoid ?

A 
Opioid analgesics
Sedatives
Barbituates
NSAIDs
OTC Meds/Herbs
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19
Q

What is the purpose of hemodynamic monitoring?

A

More accurate measurement of vascular capacity, blood volume, pump effectiveness and tissue perfusion.

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20
Q

When should a patient with chronic pancreatitis take their enzyme replacement?

A

With meals and snacks but avoid mixing it (literally mixing) with protein.

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21
Q

How is cirrhosis diagnosed?

A

Abnormal liver enzymes.

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22
Q

What happens to BUN during AKI?

A

Increases 10-20 at same pace as Cr

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23
Q

What are the signs and symptoms of DIC?

A 
Massive pain
Stroke like symptoms
Dyspnea
Tachycardia
Bowel necrosis
Decrease kidney function
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24
Q 
Blood or fluid loss
Blood pressure meds resulting in hypotension
ASA/ibuprofen/Naproxen
Severe burns
Severe dehydration

Prerenal/Intrarenal/Postrenal?

A

Prerenal

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25
Q

What if a patient comes back from hemodialysis tired and tachycardic?

A

Its okay, lay them flat, tell them to rest, put them on safety precautions.

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26
Q

What happens to Hct during AKI?

A

Decreases down to 20%

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27
Q

What can Nephrotic Syndrome lead to if left untreated?

A

End Stage Kidney Disease

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28
Q

How do the 3 compensatory responses for prerenal and postrenal AKI help?

A

By increasing blood volume and improving kidney perfusion

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29
Q

What does hemodynamic monitoring give more accurate measures of?

A

Blood pressure
Heart function
Volume status

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30
Q

Normal phosphorus level? (from book)

A

3.0-4.5

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31
Q

What are the manifestations of disequilibrium syndrome?

A

Restlessness
Headache
Decreased LOC
Seizures, coma, death

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32
Q

What are the advantages of peritoneal dialysis?

A

Flexible schedule
Few hemodynamic changes
Less dietary and fluid restrictions

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33
Q

What medication is given during hemodialysis to prevent clotting?

A

Heparin

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34
Q

Where is the access for peritoneal dialysis?

A

Intra-abdominal catheter

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35
Q

When is the balloon on the catheter for hemodynamic monitoring deflated?

A

Once it reaches the pulmonary artery

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36
Q

What are the complications of peritoneal dialysis?

A 
Protein loss
Peritonitis
Hyperglycemia
Respiratory distress
Bowel perforation
Infection
Weight gain during dwell time
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37
Q 
No blood pressures
No needle sticks
Palpate and auscultate 
Checking distal pulses and cap refill
Assessing ROM
Monitoring for infection
No tight bandages
Teaching patient no heavy weight lifting or carrying

This is nursing care for what?

A

AV fistula or graft

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38
Q

What happens during biliary obstruction?

A

Production of bile is decreased. Without bile, vitamin K cannot be absorbed. Without vitamin K, clotting factors, II, VII, IX and X are not produced. This leads to bleeding and easy bruising.

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39
Q

A complex cognitive syndrome that results from liver failure and cirrhosis.

A

Hepatic Encephalopathy

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40
Q

Chronic Kidney Disease Assessment:

Skeletal

A

Osteodystrophy

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41
Q

Multiple myeloma
TTP (clotting disorder)
Vasculitis
Kidney ischemia

Prerenal/Intrarenal/Postrenal?

A

Intrarenal

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42
Q

What are the signs/ symptoms of actue pancreatitis?

A 
Pain in epigastric/LUQ
Boring pain
Sudden onset
Pain that radiates to back, left shoulder and flank area
Jaundice
Nausea and vomiting
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43
Q

What respiratory complications are often assessed for a patient with acute pancreatitis?

A

Pneumonia (because they are laying in bed)
Pleural effusion (fluid outside of lungs)
Atelectasis ( collapsed lung)
Dyspnea

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44
Q

GFR for Stage 2 Chronic kidney disease?

A

60-89mL/min

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45
Q

Where is the access for hemodialysis?

A

Vascular access route

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46
Q

Crackles
Dependent/ generalized edema
Decreased O2 saturation
Increased Respiratory Rate

These are clinical manifestations of what?

A

Fluid volume overload

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47
Q

How does the liver feel during the late stages of cirrhosis?

A

Shrinks

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48
Q

What happens to Cr during CKD?

A

Increase 0.5-1 every 1-2 years

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49
Q

GFR for Stage 4 Chronic kidney disease?

A

15-29mL/min

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50
Q

Describe postrenal (AKI)

A

Urine flow obstruction

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51
Q

What are the physical appearance of patients with ITP?

A

Ecchymoses or petechial rash on arms, legs and upper chest or neck.

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52
Q

When is protein restriction indicated for a patient with CKD?

A

When the GFR is reduced.

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53
Q

How does hemodynamic monitoring work?

A

The catheter receives the pressure waves from the heart or the great vessels. The transducer concerts the mechanical energy into electrical energy, which is displayed as waveforms or numbers on the monitor.

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54
Q

DIC that happens rapidly and is often seen in patients with sepsis.

A

Acute DIC

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55
Q

How does the liver feel during the early stages of cirrhosis?

A

Enlarged, firm or hard

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56
Q

What happens to BUN during CKD?

A

Increase – can reach 180-200 before manifestations develop

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57
Q

What is the best way to monitor kidney function?

A

Monitoring lab values

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58
Q

How will the bruit sound if a clot is present?

A

There will be no sound

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59
Q

What are the three causes of Acute Kidney Injury?

A

Prerenal
Intrarenal
Postrenal

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60
Q

Normal Hgb level? (include male to female)

A

12-18

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61
Q 
Massive proteinuria
Hypoalbuminemia
Edema
Lipiduria
Hyperlipidemia
Increased coagulation
Reduced kidney function

These are all manifestations of?

A

Nephrotic Syndrome

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62
Q

What causes cirrhosis?

A

Hepatitis C
Alcohol
Biliary obstruction
Hepatotoxic drugs and chemicals

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63
Q

Chronic Kidney Disease Assessment:

Urine

A

Different for each patient or kidney function

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64
Q 
Gram - sepsis
Liver disease
Burns
Extensive surgeries
Trauma
Metabolic acidosis
Prosthetic devices
Cancers

are all what?

A

Triggers for DIC

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65
Q

Which coagulation disorder is most emergent?

A

DIC

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66
Q

How do you treat ascites?

A

Low sodium

Paracentesis

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67
Q

How do you assess an AV fistula?

A

Bruit and Thrill

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68
Q

Chronic Kidney Disease Assessment:

Hematologic

A

Anemia

Bleeding abnormalities

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69
Q

Nursing interventions for Stage 2 Chronic Kidney Disease?

A

Reduce risk factors

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70
Q

Why are diuretics not given to patients in end stage kidney disease?

A

They are not helpful for these patients

71
Q

Nursing interventions for Stage 4 Chronic Kidney Disease?

A

Manage complications.
Discuss patient preferences and values.
Educate about options and prepare for renal replacement therapy.

72
Q

True/False: As a nurse, you cannot question any nephrotoxic drugs the physician has ordered for your AKI patient.

A

FALSE!

73
Q

What happens to phosphorus levels during AKI?

A

Increases

74
Q

True/False: Patients with ITP need to be on bleeding precautions.

A

True!

75
Q

What are two forms of renal replacement therapies?

A

Hemodialysis and peritoneal dialysis

76
Q

An invasive system used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion.

A

Hemodynamic monitoring

77
Q

The collection of free fluid within the peritoneal cavity caused by increased hydrostatic pressure from portal hypertension.

A

Ascites

78
Q

What is the criteria for oliguria?

A

100-400 mL of urine/day

79
Q

What are the advantages of hemodialysis?

A

Most efficient way to clear out wastes

Short time needed for treatment

80
Q 
Choleylithiasis
Chronic ETOH consumption
High triglycerides
Injury to the pancreas
Toxic drugs

These are all causes of what?

A

Acute pancreatitis

81
Q

GFR for Stage 3 Chronic kidney disease?

A

30-59mL/min

82
Q

Nursing interventions for Stage 1 Chronic Kidney Disease?

A 
Screen and reduce risk for:
Uncontrolled hypertension
DM
Chronic kidney infection or UTI
Family history of genetic kidney disease
Exposure to nephrotoxic substanced
83
Q

Nursing interventions for Stage 3 Chronic Kidney Disease?

A

Implement strategies to slow progression of disease

84
Q

How do you identify the phlebostatic axis?

A

Position the patient supine.
Palpate the 4th intercostal space.
Follow the 4th intercostal space to the side of the chest.
Determine the midway point between the anterior and posterior.
Find the intersection between the midway point and the line from the 4th intercostal space and make it with an X.

85
Q

What is a dialyzer?

A

The machine that filters the blood (the artificial kidney)

86
Q

What happens to a platelets when a patient with ITP is taking corticosteroids?

A

The platelets will shoot up but as soon as the medication is stopped, the platelets will come back down.

87
Q

When is sodium restricted for patients with CKD?

A

When there is little or no urine output.

88
Q

What happens to Hgb during AKI?

A

Decreases

89
Q

Why is a patient on 3-4 ml continuous flush NS when they are on hemodynamic monitoring?

A

Because it keeps the patient open.

90
Q

What is the criteria for anuria?

A

<100 mL of urine/day

91
Q

Which coagulation disorder has clotting throughout small blood vessels and clots block blood flow to organs?

A

DIC

92
Q

What often occurs with Nephrotic Syndrome as a cause and/or effect?

A

Renal Vein Thrombosis

93
Q

Where is the catheter for hemodynamic monitoring inserted?

A

Through a large vein (usually the internal jugular or subclavian) and directs it to the right atrium.

94
Q

GFR for Stage 1 Chronic kidney disease?

A

> 90mL/min

95
Q

What happens to potassium levels during AKI?

A

Increases

96
Q

How long does hemodialysis take?

A

3-6 hours

97
Q

What are the complications of hemodialysis?

A 
Disequilibrium syndrome
Muscle cramps
Headache
Itching
Hemodynamic and cardiac reactions
Infection
98
Q

Nephrotic Syndrome diet

Normal GFR

A

Complete proteins are needed

99
Q

What happens to kidney function in Chronic kidney disease?

A

It does not return

100
Q

How is ITP diagnosed?

A

With a decrease in platelet count and an increase in Megakaryocytes.

101
Q

DIC that happened slowly and last several weeks, thrombosis and clotting may predominate mainly seen with cancer.

A

Chronic DIC

102
Q

What are some medications that patients with ITP take to suppress immune function?

A

Corticosteroids
Azathioprine
IV Immunoglobulin
Low doses of chemo

103
Q

What are the 3 compensatory responses for prerenal AKI and postrenal AKI?

A

Constricting blood vessels
Activate the Renin-angiotension-aldosterone pathway
ADH is released

104
Q

What are five complications of cirrhosis?

A 
Ascites
Portal hypertension
Biliary obstruction 
Hepatic encephalopathy
Gastroensophageal varices
105
Q

What drugs are used to manage Nephrotic syndrome?

A

Suppressive therapy
Ace Inhibitors (decreases protein loss in urine)
Cholesterol lowering drugs (improves blood lipid levels)
Heparin (reduce vascular defects and improve kidney function)
Diuretics and Sodium restrictions (reduce edema and control hypertension

106
Q

What components are involved for a pressure monitoring system for hemodynamic monitoring?

A

Catheter with an infusion system
A transducer
A monitor

107
Q

What is the specific protein given to patients with AKI?

A

40 grams

108
Q

What do you do if your patient comes back from dialysis and presents with symptoms of disequilibrium syndrome?

A

Call doctor and prepare to administer anti-convulsants and barbituates.

109
Q

What is the equation for mean arterial pressure?

A

(SBP/[2 x DBP])/3

110
Q

When does a patient with ESKD need more protein in their diet?

A

When they are receiving dialysis.

111
Q

True/ False: hemodynamic monitoring does not need an informed consent.

A

False, because if though complications are uncommon, it does involve significant risks.

112
Q

Nephrotic Syndrome diet

Decreased GFR

A

Dietary protein intake must be decreased

113
Q

What is the fluid intake given to patients with AKI?

A

Urine output plus 500 mL

114
Q

Normal Sodium level?

A

135-145

115
Q

What is Cirrhosis?

A

Extensive and irreversible scaring of the liver which leads to hepatic inflammation and necrosis.

116
Q

What happens to Cr during AKI?

A

Increase 1-2 ever 24-48 hours

117
Q

Why are replacement enzymes for patients with chronic pancreatitis administered after antacids or H2 Blockers?

A

Because antacids and H2 Blockers will decrease the pH and decreased pH will inactivate the replacement enzyme.

118
Q

What blood pressure medications are given to patients with chronic kidney disease?

A

ACE’s and CCB’s

119
Q

What are the contraindications of peritoneal dialysis?

A

Active inflammatory GI disease
Ascites
Recent abdominal surgery

120
Q

Chronic Kidney Disease Assessment:

GI

A

Foul breath

Mouth inflammation/ ulceration

121
Q

What are the early signs and symptoms of Hepatic Encephalopathy?

A

Sleep disturbances
Mood disturbances
Mental status changes
Speech problems

122
Q

What temperature should dialysate be kept at?

A

At room temperature.

123
Q

Liver failure
Anaphylaxis
Bleeding/clotting
Atherosclerosis

Prerenal/Intrarenal/Postrenal?

A

Prerenal

124
Q

Normal Cr level? (include male to female)

A

0.5-1.2

125
Q

Why is protein restricted for a patient with a reduced GFR?

A

Because buildup of wast products from protein breakdown is the main cause of uremia.

126
Q

What happens to sodium levels during AKI?

A

Can increase. decrease or stay normal

127
Q

What are the signs and symptoms of TTP?

A 
Anemia
Weakness
Chronic fatigue
Confusion
Low grade fever
Bleeding
Bruising
128
Q

How do you manage a patient with DIC?

A

Treat underlying cause (example– treat sepsis with antibiotics)
Give heparin (to limit clotting)
Give RBCs and FFP when DIC is progressed.

129
Q 
Metallic taste in mouth
Anorexia
Nausea
Vomiting
Muscle cramps
Uremic "frost" on skin
Itching
Fatigue and lethargy
Hiccups
Edema
Dyspnea
Parathesias

Key Features of what?

A

Uremia

130
Q

Chronic Kidney Disease Assessment:

Skin

A

Yellow or darkened discoloration
Decreased turgor
Uremic Frost
Rash and ecchymosis

131
Q

How does dialysis work?

A

It removes excess fluids and wast products and restores chemical and electrolyte balance.

132
Q

Enlarged prostate
Kidney stones
Nerve damage to bladder nerves
Blood clots in urinary tract

Prerenal/Intrarenal/Postrenal?

A

Postrenal

133
Q

What are the nursing interventions for a patient with HIT?

A

Stop the heparin
Give thrombin inhibitors
Treat active thrombosis
Prevent new thrombosis

134
Q

Which coagulation disorder is an immune response that causes platelets to clump in capillaries?

A

TTP

135
Q

Bladder cancer
Cervical cancer
Colon cancer
Prostate cancer

Prerenal/Intrarenal/Postrenal?

A

Postrenal

136
Q

What are two classification Systems for severity and outcomes of Acute Kidney Injury?

A

RIFLE and KDIGO

137
Q

Describe azotemia.

A

Retention of nitrogenous waste

138
Q

Why does steatorrhea occur in patients with chronic pancreatitis?

A

Because fat cannot be broken down

139
Q

What happens to calcium levels during AKI?

A

Decreases

140
Q

Why is it important to implement interventions quickly in order to fix the underlying cause of AKI?

A

Because fixing the problem quick can prevent end stage kidney disease and the need for life long therapy.

141
Q

GFR for Stage 5 Chronic kidney disease?

A

<15mL/min

142
Q

When fragile thin walled esophageal veins become distended and tortuous from increased pressure.

A

Esophageal varices

143
Q

What happens to Magnesium levels during AKI?

A

Increases

144
Q

Which platelet disorder?

The body creates the an antibody that covers the platelet and destroys it?

A

ITP

145
Q

What is the main feature associated with Nephrotic Syndrome?

A

Severe proteinuria

more than 3.5 g of protein in a 24 hour urine sample

146
Q

Why is the kidney function affected in patients with DIC?

A

Because the bleeding from multiple sites of the body decreases blood/fluid volume.

147
Q

What are the nursing interventions for ascites paracentisis?

A

Do not move
Watch LOC
Watch respiratory rate

148
Q

What are the complications associated with cirrhosis?

A 
Portal hypertension
Biliary obstruction
Hepatic encephalopathy
Hepatorenal Syndrome
Ascites
Esophageal varices
Hemorrhage
149
Q

Why are patients with CKD at a higher risk of digoxin toxicity?

A

Because the drug is excreted by the kidneys.

150
Q

What is the specific amount of sodium given to patients with AKI?

A

60-90 grams

151
Q

What is significant of polyuria and AKI?

A

Polyuria can be the start of recovery from AKI

152
Q

Glomerunonephritis
Hemolytic uremic syndrome
Nephrotoxic drugs
Scleroderma

Prerenal/Intrarenal/Postrenal?

A

Intrarenal

153
Q

Why are patients with CKD receiving erythropoietin stimulating agents?

A

Because it prevents anemia by stimulating red blood cell growth and maturation in the bone marrow.

154
Q

What are the signs and symptoms of pancreatitis?

A 
Jaundice
Gray-Blue area on Flank/Abdomen
Absent or decreased bowel sounds
Ascites
Fetal position
155
Q

Describe the diet considerations for Cirrhosis

A 
Small frequent meals
High carbs
High proteins
Moderate fat
Moderate vitamins
156
Q

Describe Intrarenal (AKI)

A

Damage to Kindey

157
Q

What is dialysate?

A

Fluid for exchanges

158
Q

A persistent increase in pressure within the portal vein greater than 5 mm Hg.

A

Portal Hypertension

159
Q

What are the lab values you will see in a patient with DIC?

A

Prolonged PT/PTT
Decreased Platelets
Decreased Fibrinogen
Positive D Dimer (indicates DVT)

160
Q

Describe Prerenal (AKI)

A

Decrease in prefusion

161
Q

What are the late manifestations of cirrhosis?

A 
Ascites
Clotting disorders
Bruising
GI Bleeding
Jaundice
Elevated ammonia levels
Hepatic encephalitis
162
Q

What are the negatives to the 3 compensatory responses for prerenal and postrenal AKI?

A

It will reduce urine output which can lead to oliguria and azotemia.

163
Q

A condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted.

A

Nephrotic Syndrome

164
Q

What happens when the catheter for hemodynamic monitoring reaches the right atrium?

A

The physician will inflate the balloon and the catheter will advance with flow of blood through the tricuspid valve into the right ventricle, past the pulmonic valve until the tip reaches the pulmonary artery.

165
Q

How do you assess a thrill?

A

Feel the vibration.

166
Q

Why are calcium channel blockers given to patients with AKI?

A

because they prevent the movement of calcium into the kidney cells, maintain kidney cell integrity, and improve kidney blood flow.

167
Q

Ingested toxins (alcohol/ cocaine)
Bleeding in the kidney
Local/ systemic infection

Prerenal/Intrarenal/Postrenal?

A

Intrarenal

168
Q

What is the number one cause of chronic pancreatitis?

A

Alcoholism

169
Q

What position must a patient be in to give off the most accurate numbers for hemodynamic monitoring?

A

Supine because they are laying on their spine.

170
Q

What are the contraindications of hemodialysis?

A

Hemodynamic instability
Severe vascular disease that prevents access
Uncontrolled diabetes

171
Q

What type of diet is needed for patients with chronic pancreatitis?

A

High protein.

172
Q

How do you assess a bruit?

A

Listen to is “swoosh” sound

173
Q

What are examples of vascular access complications?

A

Thrombosis or stenosis
Infection
Aneurysm formation
Ischemia to distal area

Advanced Med Surge (4 decks)

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